Mammographic features and screening outcome in a randomized controlled trial comparing digital breast tomosynthesis and digital mammography.

PURPOSE: To compare the distribution of mammographic features among women recalled for further assessment after screening with digital breast tomosynthesis (DBT) versus digital mammography (DM), and to assess associations between features and final outcome of the screening, including immunohistochemical subtypes of the tumour. METHODS: This randomized controlled trial was performed in Bergen, Norway, and included 28,749 women, of which 1015 were recalled due to mammographic findings. Mammographic features were classified according to a modified BI-RADS-scale. The distribution were compared using 95 % confidence intervals (CI). RESULTS: Asymmetry was the most common feature of all recalls, 24.3 % (108/444) for DBT and 38.9 % (222/571) for DM. Spiculated mass was most common for breast cancer after screening with DBT (36.8 %, 35/95, 95 %CI: 27.2-47.4) while calcifications (23.0 %, 20/87, 95 %CI: 14.6-33.2) was the most frequent after DM. Among women screened with DBT, 0.13 % (95 %CI: 0.08-0.21) had benign outcome after recall due to indistinct mass while the percentage was 0.28 % (95 %CI: 0.20-0.38) for DM. The distributions were 0.70 % (95 %CI: 0.57-0.85) versus 1.46 % (95 %CI: 1.27-1.67) for asymmetry and 0.24 % (95 %CI: 0.16-0.33) versus 0.54 % (95 %CI: 0.43-0.68) for obscured mass, among women screened with DBT versus DM, respectively. Spiculated mass was the most common feature among women diagnosed with non-luminal A-like cancer after DBT and after DM. CONCLUSIONS: Spiculated mass was the dominant feature for breast cancer among women screened with DBT while calcifications was the most frequent feature for DM. Further studies exploring the clinical relevance of mammographic features visible particularly on DBT are warranted.

Coping with exacerbation in psoriasis and eczema prior to admission in a dermatological ward.

Chronic dermatologic diseases, such as psoriasis and eczema, may cause significant psycho-social problems and stress. Our objectives were to characterize how hospitalised patients coped with psoriasis and eczema, and to investigate the relationship between coping and quality of life. Data are based on survey forms completed upon admission to the dermatology ward from 212 patients with chronic dermatological diseases, 146 with psoriasis and 66 with eczema. 108 were men, average age 48 years. The Norwegian versions of the standardized survey questionnaires, Jalowiec Coping Scale and Dermatological Life Quality Index, were used to evaluate coping and quality of life. We found that optimism, belief-in-oneself and confrontational coping strategies were most frequently used. Long duration of the disease was correlated to the belief-in-oneself strategy, while short duration was related to supportive strategies. More frequent use of confrontational and optimistic modes was significantly related to better quality of life. More frequent use of emotional and evasive modes was significantly related to poorer quality of life. There was no significant difference between the psoriasis and eczema groups in terms of use of coping strategies, with exception of emotional strategies. Knowledge of coping strategies and quality of life among patients with chronic dermatological diseases is important for improvement in health services for these patients.

Self-reported quality of life and the effect of different clinical and demographic characteristics in people with type 1 diabetes.

The aims of the present study were to describe how people with type 1 diabetes experienced their quality of life and to examine the effect of the different background characteristics of sex, age, social status, education, disease duration. HbA1 levels, regimen and the frequency of complications on self-reported quality of life. A self-administered questionnaire consisting of 28 items measuring satisfaction within the physical, psychological, social and activity/behavioural life-domain and 11 well-being scales was completed by 247 patients with type 1 diabetes who consecutively attended a Norwegian diabetes clinic. Main findings from the study showed that over 80% of patients reported their capacity for self-care, general well-being, satisfaction with life and social contacts to be quite good or better. Forty five percent of patients perceived their life situation to be negatively effected due to diabetes. Multivariate analysis showed that living alone had a negative effect on satisfaction in the physical, social and psychological life-domain. Higher levels of HbA1 were associated with reported lower satisfaction within the physical and activity/behavioural life-domain. The effect of the different background characteristics on reported well-being showed no consistent pattern. These findings indicate that the majority of patients in this study experienced a satisfactory quality of life despite living with a chronic illness such as diabetes.

The effects of participation in a support group on self-assessed quality of life in people with insulin-dependent diabetes mellitus.

The aim of the present study was to examine the effect of participation in a support group on self-assessed quality of life. Based on an initial self-report assessment of quality of life 25 people were allocated to 5 groups comprising 4-6 participants (intervention group) and 36 controls. The support groups met fort-nightly for 6 months and were facilitated by the investigator and a diabetic nurse specialist. Group processes were aimed at alleviating distress and improve satisfaction with life and included installation of hope, imparting information and group cohesiveness. Both the intervention and control group completed the quality of life measure at the end of 6 months. There were no significant differences between the intervention and control group on background characteristics or quality of life pre-test scores. No significant differences were found between the intervention and control group on difference in pre and post-test scores, indicating that support group participation did not effect self-assessed quality of life. This finding may be due to methodological issues i.e. selection, sample size and the instrument used, the implementation of the intervention and/or the concept of quality of life as an outcome variable.

Validation of a Norwegian version of the Burn Specific Health Scale.

BACKGROUND: The abbreviated Burn Specific Health Scale (BSHS-A) is an 80-item questionnaire that has proven useful in measuring physical, mental, social and general health in burn survivors. The aim of this study was to adapt the BSHS-A into Norwegian, including assessing reliability and validity. METHODS: Standard procedures for forward and backward translation including discussions with professionals and patients to ensure conceptual equivalence were used. A pilot study (11 burn patients) confirmed that the Norwegian version (BSHS-N) was clear, understandable and easy to self-administer. Subsequently, 95 adults admitted to the Burn Center, Haukeland University Hospital, between 1995 and 2000 entered a validation study by completing the BSHS-N and the general health measure SF-36. Sixty-nine of the 95 (72%) responders completed a retest. RESULTS: The overall internal consistency reliability (Cronbach's alpha=0.97) and the test-retest reliability (ICC=0.95) for the BSHS-N were satisfactory. Tests for criterion validity showed expected patterns for association between comparable domains in the BSHS-N and the SF-36, with correlations ranging from r=0.61 to 0.81. Tests for construct validity showed that patients with full thickness injury (P=0.003), patients hospitalised more than 10 days (P=0.003), patients undergoing more than two operations (P=0.001) and patients unemployed at the time of study (P<0.001), had significantly lower total scores than the rest of the patients. CONCLUSION: BSHS-N seems to be a reliable and valid instrument for use in the Norwegian population. The translation and cross-cultural adaptation of this instrument allows for comparative international studies.

Nursing intervention to increase hope and quality of life in newly diagnosed cancer patients.

The aim of this study was to evaluate the effect of nursing intervention on hope and quality of life in cancer patients. The sample consisted of 96 newly diagnosed Norwegian cancer patients ages 26 to 78 years, the majority of them women (71%). Breast cancer was the predominant type of cancer in this sample. The study used an experimental design in which patients were randomly allocated to three different groups. The first group was the experimental group, for which the intervention was designed to increase hope. The second group (attention control group) participated in the "Learning to Live with Cancer" program. The last group was a control group. The Nowotny Hope Scale was used to measure hope, and the Ferrans and Powers Quality of Life Index and the Cancer Rehabilitation and Evaluation Systems, short form, were used to measure quality of life. The questionnaires were completed four times: twice before, then 2 weeks and finally 6 months after the intervention. The level of hope was significantly increased (p = 0.020) for the members of the hope group just after the intervention, but not after 6 months. Despite the patients' positive evaluation of the intervention, there was no impact on quality of life.

Changes in pain, stiffness and physical function in patients with osteoarthritis waiting for hip or knee joint replacement surgery.

OBJECTIVE: Little has been reported on changes in health status in patients with osteoarthritis (OA) while waiting for hip or knee replacement surgery. In this study we assessed (1) changes in self-reported pain, stiffness and physical function in patients with OA of the hip or knee, from the decision to undergo surgery to 14 days prior to surgery, and (2) the determinants of these changes. METHODS: Among 353 baseline respondents, 170 waited >30 days for surgery, completed the Western Ontario and McMaster Universities Arthritis Index (WOMAC) before surgery and were included in the analysis of changes; 120 with OA of the hip and 50 of the knee. We analyzed changes in WOMAC scores using the paired t test and determinants of the changes using multiple linear regression. RESULTS: Patients with OA of the hip did not change on any WOMAC scale before surgery. Knee patients deteriorated with time on the WOMAC stiffness and total scales, but not on the pain or physical function subscales. In both patient categories, higher baseline WOMAC scores were associated with smaller changes on all subscales and the total score, and female sex was associated with deterioration on the pain subscale. CONCLUSIONS: Patients with OA of the hip reported no change in pain, stiffness or physical function while waiting for joint replacement surgery, whereas patients with OA of the knee deteriorated on the stiffness and total scales of the WOMAC. This suggests a difference in patient selection, referral pattern or disease development between the patient categories.

Postoperative pain and convalescence in living kidney donors-laparoscopic versus open donor nephrectomy: a randomized study.

The aim of the present study was to compare postoperative pain and convalescence in patients randomized to laparoscopic or open donor surgery in a prospective, controlled trial. The donors were randomly assigned to undergo laparoscopic (n = 63) or open (n = 59) donor nephrectomy. Our end points were amount of administered analgesics in the recovery period, postoperative pain on the second postoperative day and at one month after surgery and duration of sick leave. There was a significant difference in favor of the laparoscopic group regarding administered analgesics on day of surgery (p < 0. 02). No difference was observed between groups regarding self-reported pain on the second postoperative day. One month post donation, significantly fewer donors in the laparoscopic group reported pain (p < 0. 02) or had used analgesics (p < 0.05). The duration of sick leave was significantly shorter in the laparoscopic group (p = 0.01). The laparoscopic group experienced a more rapid convalescence and a shorter period of sick leave. Although immediate postoperative pain can be managed efficiently regardless of procedure, a lower consumption of opioids and incidence of pain in the convalescent period suggest a clinically relevant patient-experienced benefit from a successful laparoscopic procedure.

How important are men's lower urinary tract symptoms (LUTS) and their impact on the quality of life (QOL)?

PURPOSE: To investigate the extent to which symptom severity and related factors contribute to the explained variance of the quality of life (QOL) of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). METHODS: Data from 480 men awaiting urological assessment were collected by questionnaires shortly after referral by their general practitioners in 1997-2000. The World Health Organization's QOL questionnaire (WHOQOL-bref), International Prostate Symptom Score (I-PSS), Symptom Problem Index (SPI), International Continence Society Benign Prostatic Hyperplasia questionnaire (ICS-BPH), the Sandvik Incontinence Severity Index, and BPH Specific Impact on Activity (BSIA) were used. RESULTS: Regression analyses with WHOQOL-bref scores as dependent variables (physical, psychological, social relations, environmental domains, as well as overall QOL and general health) showed that symptom severity predicted only physical health. The severity of urinary incontinence was predictive of all domains except general health. Sexual function was predictive of all domains. Regression coefficients were close to zero. The explained variance of WHOQOL-bref scores was low (5-17%). CONCLUSIONS: The WHOQOL-bref might be too comprehensive to identify associations between specific symptom-related factors. Alternatively, our results indicate that LUTS suggestive of BPH and LUTS-associated factors are not very important determinants of QOL.

Evaluation of a programme of group visits and computer-assisted consultations in the treatment of adolescents with Type 1 diabetes.

AIM: To examine the effects of group visits and computer-assisted consultations on quality of life and glycaemic control in adolescents with Type 1 diabetes. METHODS: A total of 116 adolescents, aged 11-17 years, and their parents were randomly assigned to an intervention (n = 62) or a control group (n = 54). The intervention group was invited to a 15-month programme comprising group visits and computer-assisted consultations. The control group was offered traditional out-patient consultations. Outcomes included changes in HbA(1c) and the adolescents' assessment of generic and disease-specific health-related quality of life measured by the Child Health Questionnaire (CHQ-CF87) and the Diabetes Quality of Life Questionnaire (DQOL), respectively. RESULTS: One hundred and one adolescents (55/46) agreed to participate, mean age 14.2 years (sd 1.5), mean diabetes duration 6.5 years (sd 3.6, range 1-16 years), mean HbA(1c) 9.3% (sd 1.4, range 6.1-12.8%). Eighty-three (72%) completed the questionnaires at follow-up (intervention/control 45/38). There were significant age by randomization group interactions for diabetes-related impact (P = 0.018), diabetes-related worries (P = 0.004), mental health (P = 0.046) and general behaviour (P = 0.029), implying that the intervention was effective in older adolescents (above 13-14 years). No significant effects on mean HbA(1c) were identified. CONCLUSIONS: Group visits and computer-assisted consultations had beneficial effects on health-related quality of life in older adolescents, the role of this intervention being questionable in younger adolescents.

[Quality of life connected with nursing practice and research--some challenges]. / Livskvalitet knyttet til sykepleiepraksis og forskning--noen utfordringer.

Quality of life is increasingly being recognized as an important outcome in patient care. In spite of the popularity of the concept, its use is not without difficulties. Because quality of life is a subjective phenomenon it is not easy to define, as no gold standard exists as to what is a good life. This has resulted in different definitions of quality of life as well as discrepancies of design and development of instruments to measure the construct within different sciences. The usefulness of quality of life within nursing research and practice is dependent on: 1) the way the concept is defined and operationalized, 2) the clinical relevance of the questions raised in the study, 3) study design and 4) further methodological development.

Errors of measurement affecting the reliability and validity of data acquired from self-assessed quality of life.

Research often uses self-assessed quality of life. Quality of life cannot be observed directly; other variables have to serve as its indicators. In the case of self-assessed quality of life, the researcher has to rely upon the individual's own statement as to how she/he feels. The subjective nature of the term creates problems in the matter of reliability and validity of the data thus collected. Random and systematic errors of measurement are liable to influence the result of the investigations. The researcher must know the possible sources of error and make allowances for them if research into quality of life is to be a worthwhile contribution to a greater understanding of what is meant by having a good life, and of the means to achieve it.

Insulin-dependent diabetes mellitus and quality of life. A theoretical analysis.

Insulin-dependent diabetes mellitus (IDDM) affects the overall life situation of the individual. The term "quality of life" means each individual person's estimation of what it means to have a good life. There are many aspects of diabetes which will influence to a greater or lesser extent each individual's degree of satisfaction with his/her life. This theoretical analysis shows that there is no direct connection between reduced quality of life and IDDM. There is a need, however, for empirical investigations which will provide a better understanding of the relationship between quality of life and IDDM.

Nurses' perceptions of the content, relevance and usefulness of the quality of life concept in relation to nursing practice.

The aim of this study was to investigate how nurses define the quality of life concept and if they find it relevant and useful for their daily practice. Eighteen nurses recruited from a neurological and rheumatologic unit at a Norwegian University Hospital filled in a questionnaire consisting of four open-ended questions in relation to the definition of quality of life, the concept's relevance for their daily practice, characteristics of a patient experiencing good vs. bad quality of life and ways to improve quality of life. The findings showed that nurses associated quality of life with the individual's experience of meaning in life. Meaning in life was associated with good mood, positive self-concept, being solution-oriented, initiative to self-care and having a close relationship to significant others. Further, the nurses expressed that their way of being towards the patients in terms of give time, encourage, inspire confidence, be present and listen was the most important intervention to maintain or increase patients' quality of life.

The stability of quality of life experience in people with type 1 diabetes over a period of a year.

The aim of the present study was to examine the stability of self-reported quality of life experience over a period of 1 year using a standard measure consisting of 29 items measuring satisfaction in the physical, social, psychological and behavioural/activity life domains and 11 well-being scales. One hundred and six people with Type 1 diabetes attending a Norwegian diabetes clinic participated in the study. At first and second assessment, questionnaires were administered and completed at the diabetes clinic. Regression coefficients for the linear relationship between the assessments were relatively high indicating stability in reported quality of life experience over a period of 1 year. Comparisons between subjects experiencing life events relating to personal and/or family problems during the 12-month period and those not showed that, in addition to stability coefficients being relatively high for both groups, the majority of the stability coefficients for the group reporting life events were not significantly different from the stability for the group reporting no life events.

Quality of life, perceived difficulties in adherence to a diabetes regimen, and blood glucose control.

The first aim of the present study was to investigate if self-assessed quality of life was associated with perceived difficulties in adherence to a regimen, and the second, if perceived difficulties in adherence were associated with poor blood glucose control. A self-administered questionnaire was completed by 247 patients with Type 1 self-administered questionnaire was completed by 247 patients with Type 1 diabetes who consecutively attended a Norwegian diabetes clinic. Results from multiple linear regression analysis indicated that a higher level of quality of life was associated with greater perceived ease of adherence to the regimen. Adherence to control of smoking, increased physical exercise, and control of weight and diet were perceived as most difficult. Analysis of covariance showed that women who perceived difficulties in adherence to self-care behaviour had on average less satisfactory blood glucose control than those reporting less difficulty in adherence.

Nursing intervention to increase hope in cancer patients.

Hope is considered to be of great significance for people diagnosed as having cancer, and is thus an important aspect of nursing care. It is therefore of value to document ways in which hope can be strengthened in these patients. An intervention programme based on Nowotny's (1986) definition of hope and designed to increase hope in groups of cancer patients with the nurse as the group leader was developed. The intervention was divided into eight sessions, each of which focused on a different aspect of hope. These included: belief in oneself and one's own ability, emotional reactions, relationships with others, active involvement, spiritual beliefs and values, and acknowledging that there is a future. By focusing on these aspects through interactional processes in the group, it was thought that the participants' hope could be strengthened.

Self-assessed quality of life and metabolic control in persons with insulin-dependent diabetes mellitus (IDDM).

The aim of the study was to analyse the association between satisfaction with life and glycosylated haemoglobulin (HbA1). A quality of life questionnaire was administered to 247 persons with IDDM at a Diabetic Clinic in Bergen, Norway. The material was divided into two groups depending on their level of HbA1; HbA1 greater than 0.09 was labelled poorly regulated and a level of HbA1 less than or equal to 0.09 was labelled well regulated. The groups were compared with regard to different life domains and well-being scales. The statistical analysis showed that the well-regulated group had significantly higher average scores considering the somatic and activity/behavioural life domain ratings, the latter being only significantly different among people with higher education. The well-regulated group had lower average scores in the psychological and social life domain ratings, but these differences were not statistically significant. Among the well-being scales we found a statistically significant difference between poor and well-regulated persons only regarding sociability and loneliness. Well-regulated persons felt on average less sociable and more lonely than poorly-regulated persons.

Use and misuse of the concept of quality of life in evaluating surgical treatments for lower urinary tract symptoms.

OBJECTIVE: To investigate how quality of life (QoL) components measured by given instruments direct the QoL perspective in treatment studies of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). METHODS: Computer searches were conducted in Medline, CINAHL and Psychinfo; MeSH terms covering QoL and surgical treatments for BPH and LUTS were combined for the search. The analysis was based on a framework linking components of QoL to patient outcome. RESULTS: Of the 74 papers meeting the inclusion criteria, 48 were published in 1997-2001, showing the increase of interest of the topic. Most of the papers reported the change in QoL by a one-item scale, whilst only a few reported results from several of the components in the QoL concept. Some papers regarded the change in general health status or parts of health status as changes in QoL. Functional status and symptoms, and the bother of symptoms, were often regarded as indicators of a change in QoL. CONCLUSION: These analyses show an increasing interest in measuring QoL after surgery for LUTS and BPH. In most of the studies analysed, the batteries of instruments selected were too narrow in scope to study the complexity of QoL. Most papers are based on instruments sensitive to change, but the reports do not distinguish the basic assumptions for understanding relationships important in QoL research and as a result, the reason for change is open to question.

Diversity of urinary symptoms in patients tentatively diagnosed with benign prostatic hyperplasia referred to a urologic clinic in Norway.

OBJECTIVE: Lower urinary tract symptoms (LUTS) has become the preferred term used to classify the urinary symptoms of elderly men. This term places more emphasis on clinical appearance rather than being restricted to the functional pathophysiology. The objective of this study was to investigate this new concept in a group of patients who had been tentatively diagnosed with benign prostatic hyperplasia (BPH). The range of urinary symptoms, incontinence, sexual function and impact on daily living were registered. MATERIAL AND METHODS: Data from a group of 480 men awaiting urologic assessment were collected by questionnaire shortly after referral from their general practitioner between 1997 and 2000. The questionnaires used were the International Prostate Symptom Score (IPSS), the Symptom Problem Index, the International Continence Society-BPH, the Sandvik Incontinence Severity Index and the BPH-specific Interference with Activities. RESULTS: The mean age of the subjects was 67.0 years. As assessed by the IPSS, 15%, 54% and 31% of the men had mild, moderate and severe symptoms, respectively. Men who gave positive answers to questions regarding the frequency, amount and type of leakage were considered to have urinary incontinence (UI), which was found in 37% of cases. The majority of men had mild or moderate UI. Influence on daily living varied with the severity of symptoms. However, no significant differences in influence on daily living were found between groups with different degrees of severity of incontinence as all groups reported a relatively high impact. CONCLUSIONS: Our results show that UI is fairly common, very bothersome and socially embarrassing in male LUTS patients waiting for urologic evaluation. Although UI is not typically associated with BPH and is not regarded as a crucial component of LUTS, this study indicates that more emphasis should be placed on UI in the terminology of LUTS. UI may also act as an indicator of a need for healthcare.